People With Thyroid Cancer in The Nordic Region Now Able to Benefit From New Advanced Thyroid Cancer Treatment Lenvima® (Lenvatinib)

Lenvima® (Lenvatinib), a treatment for people with radioactive iodine refractory differentiated thyroid cancer (RAI refractory DTC), launches in in the Nordic region. Advanced thyroid cancer is a difficult to treat condition with a poor prognosis and Lenvima represents a significant advance for patients in the Nordic countries. Lenvatinib is indicated for the treatment of adult patients with progressive locally advanced or metastatic, differentiated (papillary, follicular, Hürthle cell) thyroid carcinoma (DTC) refractory to radioactive iodine (RAI).[1]
Lenvatinib shows a significant median 18.3 months progression free survival versus 3.6 months for placebo (hazard ratio [HR] 0.21; 99% confidence interval 0.14-0.31, p<0.0001). The response rate was 64.8% in the lenvatinib group (4 complete responses, 1.5%) and 1.5% in the placebo (P,0.001). 70.4% of patients had a complete or partial response to lenvatinib within 30 days on the 24mg dose. Lenvatinib was associated with a median time to objective response of 2 months (95% CI, 1.9-3.5). Median duration of treatment was 13.8 months with lenvatinib versus 3.9 months for placebo. SELECT is a randomised, double-blind, multicentre trial for people with progressive RIA DTC (n=392).[2] For lenvatinib, the most common treatment related adverse events were hypertension, diarrhoea, fatigue, decreased appetite, decreased weight, and nausea.
“It is a challenge to treat advanced thyroid cancer, when the possibility to offer an effective therapy is limited. The progression free survival benefit of lenvatinib represents an important milestone in the treatment of radioiodine-refractory advanced thyroid cancer (of papillary and follicular types) and is welcomed by doctors and patients alike,” commented Dr Lars Bastholt, Department of Oncology, University Hospital of Odense.
“For patients who no longer respond to radioactive iodine treatment, there are limited options. This makes the launch of lenvatinib in the Nordics countries particularly pertinent as it means patients have an effective treatment option to help fill this unmet medical need. Lenvatinib has been proven to extend progression free survival by approximately 15 months when compared to placebo,” comments Anna Wallin, Eisai Nordic Marketing Manager.
Lenvatinib, discovered and developed by Eisai, is an oral molecular tri-specific targeted therapy that possesses a potent selectivity and a binding mode different to other tyrosine kinase inhibitors (TKI). Lenvatinib simultaneously inhibits the activities of several different molecules including vascular endothelial growth factor receptors (VEGFR), fibroblast growth factor receptors (FGFR), RET, KIT and platelet-derived growth factor receptors (PDGFR). This potentially makes lenvatinib the first TKI that simultaneously inhibits the kinase activities of FGFR 1-4 as well as VEGFR 1-3.[3],[4] In addition, lenvatinib was found to have a new Type V binding mode of kinase inhibition that is distinct from existing compounds.[5]
While thyroid cancer is relatively rare, over the past few decades the incidence of the disease is rising rapidly across the whole of Europe.[6],[7] In 2012 there were approximately 1,300 new cases of thyroid cancer in Nordic countries.[7] More prevalent in women than men, at a ratio of 2 to 1, thyroid cancer is the most common endocrine malignancy.[8]
Lenvatinib has been approved for the treatment of refractory thyroid cancer in the United States, Europe and Japan, and has been submitted for regulatory approval in Switzerland, South Korea, Canada, Singapore, Russia, Australia and Brazil. Lenvima was granted Orphan Drug Designation in Japan for thyroid cancer, in the United States for treatment of follicular, medullary, anaplastic, and metastatic or locally advanced papillary thyroid cancer and in Europe for follicular and papillary thyroid cancer.
The development of lenvatinib underscores Eisai’s human health care (hhc) mission, the company’s commitment to innovative solutions in disease prevention, cure and care for the health and well-being of people worldwide. Eisai is committed to the therapeutic area of oncology and to address the unmet medical needs of patients and their families.
Notes to Editors
Lenvatinib (E7080)
Eisai is currently conducting clinical studies of Lenvima in several types of cancer including hepatocellular carcinoma (Phase III), renal cell carcinoma (Phase II), non-small cell lung cancer (Phase II) and endometrial cancer (Phase II).
About Lenvatinib’s Novel Binding Mode (Type V)[6]
Kinase inhibitors are categorized into several types (Type I to Type V) depending on the binding site and the conformation of the targeted kinase in complex with them. Most of the currently approved tyrosine kinase inhibitors are either Type I or Type II, however according to X-ray crystal structural analysis, lenvatinib was found to possess a new Type V binding mode of kinase inhibition that is distinct from existing compounds. In addition, lenvatinib was confirmed via kinetic analysis to exhibit rapid and potent inhibition of kinase activity, and it is suggested that this may be attributed to its novel binding mode.
About SELECT[3]
The SELECT (Study of (E7080) LEnvatinib in Differentiated Cancer of the Thyroid) study was a multicentre, randomised, double-blind, placebo-controlled Phase III study to compare the PFS of patients with RR- radioiodine-refractory differentiated thyroid cancer and radiographic evidence of disease progression within the prior 13 months, treated with once-daily, oral lenvatinib (24mg) versus placebo. The study enrolled 392 patients in over 100 sites in Europe, North and South America and Asia and was conducted by Eisai in collaboration with the SFJ Pharmaceuticals Group.
Participants were stratified by age (≤65, >65 years), region and ≤1 prior VEGFR-targeted therapies and randomised 2:1 to either lenvatinib or placebo therapy (24mg/d, 28-d cycle). The primary endpoint was PFS assessed by independent radiologic review. The secondary endpoints of the study included overall response rate (ORR), overall survival (OS) and safety. Rates of complete response were 1.5% (4 patients) for the lenvatinib group and zero in the placebo group. The results for partial response were 63.2% (165 patients) in the lenvatinib group and 1.5% (2 patients) in the placebo arm. The median exposure duration was 13.8 months for lenvatinib and 3.9 months for placebo and the median time to response for lenvatinib was 2.0 months. Median OS has not yet been reached.
The six most common lenvatinib treatment-related adverse events (TRAEs) of any grade were hypertension (67.8%), diarrhea (59.4%), fatigue (59.0%), decreased appetite (50.2%), weight loss (46.4%) and nausea (41.0%). TRAEs of Grade 3 or higher (Common Terminology Criteria for Adverse Events) included hypertension (41.8%), proteinuria (10.0%), weight loss (9.6%), diarrhoea (8.0%), and decreased appetite (5.4%).
Subgroup analyses presented at the European Thyroid Association Annual Meeting in September 2014 showed that lenvatinib maintained a PFS benefit in all pre-defined subgroups of people with progressive radioiodine-refractory differentiated thyroid cancer. In particular, the PFS benefit observed in 195 people with progressive radioiodine-refractory differentiated thyroid cancer in Europe (lenvatinib n=131 and placebo n=64) was similar to the PFS of overall study population (HR=0.24, [95% CI, 0.16-0.35]).[9] The median PFS with lenvatinib and placebo were 18.7 months and 3.7 months respectively.
Two recent subanalyses from the SELECT study have been presented at the Endocrine Society Congress 2015 (ENDO). The first reports the results of the open-label extension phase of SELECT and aims to assess the crossover of patients in the placebo arm to the optional open-label lenvatinib treatment period. The results highlight that patients who crossed over from the placebo arm achieved a median PFS of 12.4 months with open-label lenvatinib treatment. Although toxicities were substantial, these were generally managed with medications, dose interruption, and dose reductions.
The second abstract examines the relationship between thyroid abnormalities and their effect on the safety and efficacy outcomes in SELECT. The analysis shows that although an increase in thyroid-stimulating hormone (TSH) levels was a frequent complication, its direct relationship to lenvatinib therapy has not been established and there is no evidence TSH levels affect tumour responses to lenvatinib treatment.
About Thyroid Cancer
Thyroid cancer refers to cancer that forms in the tissues of the thyroid gland, located at the base of the throat near the trachea.[10] It is more common in women than in men and most are in their 40s or 50s at time of diagnosis.[11]
Thyroid cancer affects more than 52,000 people in Europe each year.[7] The incidence of thyroid cancer has increased significantly in the last decade by 69% and 65% in men and women, respectively.[12] The most common types of thyroid cancer, papillary and follicular (including Hurthle cell), are classified as differentiated thyroid cancer (DTC) and account for approximately 85-90% of all cases.[13],[14],[15] The remaining cases are classified as either medullary (3-4% of cases)[16] or anaplastic (1-2% of cases).Reported by PR Newswire.

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